Methods And Compositions For The Treatment Of Open And Closed Wound Spinal Cord Injuries

ABSTRACT

Devices and methods for the treatment of open and closed wound spinal cord injuries are disclosed. For example, described herein are devices and methods for mitigating secondary injury to, and promoting recovery of, spinal cord primary injuries. More particularly, certain embodiments of the present invention are directed to polymeric mini-tubes that may be used for the treatment of spinal cord injuries. In addition, other embodiments are directed to polymeric “fill-in” bandages that may be used for the treatment of spinal cord injuries. For example, an erodible, or biodegradable, form of biocompatible polymer of the present invention is fabricated for surgical implantation into the site of the spinal cord injury.

RELATED APPLICATION

Pursuant to 35 USC §120, this application is a continuation of priorU.S. application Ser. No. 14/496,742, filed Sep. 25, 2014, which is acontinuation of prior U.S. application Ser. No. 14/177,888, filed Feb.11, 2014, now U.S. Pat. No. 8,858,966, which is a continuation of priorU.S. application Ser. No. 13/741,901, filed Jan. 15, 2013, now U.S. Pat.No. 8,685,434, which in turn is a divisional application and claims thebenefit of prior U.S. application Ser. No. 11/789,538, filed Apr. 25,2007, now U.S. Pat. No. 8,377,463, which in turn claims the benefit ofprior U.S. Provisional Application 60/794,986, filed Apr. 25, 2006. Eachof these applications are incorporated by reference in its entirety.

BACKGROUND OF THE INVENTION

Many spinal cord injuries (SCIs) are a result of the spinal cord beingcompressed, not cut. Insult to the spinal cord often results invertebrae, nerve and blood vessel damage. Bleeding, fluid accumulation,and swelling can occur inside the spinal cord or outside the spinal cordbut within the vertebral canal. The pressure from the surrounding boneand meninges structure can further damage the spinal cord. Moreover,edema of the cord itself can additionally accelerate secondary tissueloss. There is considerable evidence that the primary mechanical injuryinitiates a cascade of secondary injury mechanisms including excessiveexcitatory neurotransmitter accumulation; edema formation; electrolyteshifts, including increased intracellular calcium; free radicalproduction, especially oxidant-free radicals; and eicosanoid production.Therefore, SCIs can be viewed as a two-step process. The primary injuryis mechanical, resulting from impact, compression or some other insultto the spinal column. The secondary injury is cellular and biochemical,wherein cellular/molecular reactions cause tissue destruction. Byinterrupting this second process and diffusing any compression resultingfrom the primary mechanical lesion, as well as any cord edema, healingis expedited.

As discussed above, spinal cord injury involves not only initial tissueinjury, but also devastating secondary injuries. These pathologicalevents, caused by excitotoxicity, free-radical formation and lack ofneurotrophic support, include glial scarring, myelin-related axonalgrowth inhibition, demyelination, secondary cell death such asapoptosis. For example, oligodendrocyte death continues for weeks aftermany SCIs. An environment antagonistic to axonal regeneration issubsequently formed. In addition to damaged regeneration pathways,reflexia hyperexcitability and muscle spasticity, there are furthercomplications of respiratory and bladder dysfunction, for example. Overtime, muscle mass is lost as a result of loss of innervations andnon-use. The end result of these spinal cord insults invariably is lostfunction, the extent of which is determined by the severity of thespinal cord primary lesion as well as by secondary injuries. Even in thecase of incomplete motor function loss, common problems include posture,reduced walking speed, abnormal balance and gait, and lack of sufficientweight-bearing.

Surgical decompression of the spinal cord is often used to relieve anypressure from surrounding bone (by removing fractured or dislocatedvertebrae or disks). However, the timing of surgical decompression hasbeen a controversial topic. While rat studies have shown earlydecompression to reduce secondary injury, the results in human clinicaltrials have been less than consistent. It has been difficult todetermine a time window for the effective application of surgicaldecompression intervention in the clinical setting. Furthermore, thereare no technologies which can be used to effectively control theincrease in intra-parenchyma pressure resulting from the primary SCI.The absence of such a technology renders surgical decompression surgery,in many cases, ineffective. The removal of bone and soft tissuestructures do not address the underlying problem of secondary intrinsicpressure at the SCI site. Therefore, there exists a need to providealternative devices and methods to impede the process that drivesecondary injury at the primary spinal cord injury site. Thesealternative methods can be used to complement decompression surgicalprotocols.

There has been scant, if any, therapeutic attention given to theintrinsic nature of the injured/compressed spinal cord (i.e. theinjured/compressed cord itself). As mentioned above, decompressionsurgery is directed to the extrinsic nature of the injury (i.e. removalof bone or fluid surrounding, and causing, the injury) in hopes ofalleviating consequences of intra-tissue pressure build-up. Secondaryinjury will often impede the nerve regeneration and/or nerve regrowthprocess. Consequently, there exists a need for devices and methods thatalleviate the primary spinal cord injury from, for example, secondarytissue destruction, edema formation, and an influx of inflammatoryfactors.

Furthermore, it is well known that penetrating spinal cord injuries(SCIs) are the most deadly neurotrauma encountered by people. Reports oncombat related open wound SCIs during the Vietnam war indicate that thistype of injury leads to close to 100% lethality. While there have beenadvances in the protective ability of bullet-proof vests, the neckregion of persons wearing many of today's vests is often vulnerable tomany high velocity weapons. More than 90% of SCIs are initiallydiagnosed as “incomplete,” wherein the injury does not result incomplete severing of the spinal cord. Technology which can protect thespared tissue and promote endogenous healing and repair will mitigatefunctional deficits resulting from both penetrating and contusiontraumatic SCIs.

BRIEF SUMMARY OF THE INVENTION

Certain embodiments of the present invention are directed tobiocompatible polymeric materials which can be fabricated into“mini-tubes,” or “tubular articles.” These mini-tubes can be used totreat any localized SCI. In one embodiment, the mini-tube is insertedinto the epicenter of the injury, wherein the hollow tube runs throughthe injury site. See FIG. 1. The mini-tube can be inserted through asurgical incision made rostral or caudal to the lesion to be treated.The mini-tube creates a new interface within the compressed spinal cordparenchyma. This new interface relieves the site of pressure andprotects tissue that has been spared from injury. Pressure resultingfrom the compression force exerted on the cord is alleviated by (1)diffusing or redirecting the force down the surface of the mini-tube andaway from the initial compressed site, and (2) absorbing the compressionenergy into the biocompatible material of the mini-tube. See FIG. 1.Furthermore, by providing a structure between the injured site andsurrounding tissue (the new interface), inflammation may be mitigated inthe adjacent area where functionally relevant residual cord tissue canbe spared.

In another embodiment, the present invention relates to biocompatiblepolymers fabricated into hollow mini-tubes, or tubular articles, havingan inner surface, an outer surface and two opposing ends. The mini-tubesmay be fabricated into any geometrical shape and size. For example, thesize and the shape of the mini-tube may be varied in order to delivermore effective relief. A thin, elongated cylinder is one possibleconfiguration, but other shapes, such as elongated rectangular tubes,spheres, helical structures, and others are possible. Additionalalterations in configuration, such as the number, orientation, and shapeof the mini-tubes may be varied in order to deliver more effectiverelief. For instance, the mini-tubes may be rectangular, or any otheruseful shape, and may be distributed along and/or around epicenter ofthe spinal cord injury. The size will vary accordingly with the spinalcord lesion to be treated. The mini-tube can be smaller than, the samesize as, or longer than the lesion to be treated. In preferredembodiment, the mini-tube will be longer than the length of the injuredsite. In another preferred embodiment, the length of the mini-tube to besurgically implanted will be approximately between 1.2 and 3 times thelength of the injured site or lesion running lengthwise along the spinalcord. In yet another preferred embodiment, the mini-tube will extendbeyond the caudal and rostral sides of the injured site at a distance ofapproximately ¼ the length of the injured site. In a preferredembodiment the mini-tube will extend equally beyond the caudal androstral sides of the injured site.

The diameter of the mini-tube (outer surface to outer surface; or“outside diameter”) can range from 0.1 microns to 10 millimeters. In apreferred embodiment, the overall diameter of the mini-tube (outersurface to outer surface) is between about 5 and 200 microns. In otherembodiments the diameter of the mini-tube (outer surface to outersurface) is between about 20 and 200 microns, between about 50 and 175microns, between about 100 and 200 microns, and between about 150 and300 microns. In another embodiment, the diameter of the mini-tube (outersurface to outer surface) is between about 0.5 millimeters and 20millimeters. In other embodiments, the diameter of the mini-tube (outersurface to outer surface) is between about 1 millimeter and 10millimeters, between about 1 millimeter and 5 millimeters, and betweenabout 1 millimeter and 3 millimeters.

The diameter of the mini-tube (inner surface to inner surface; or the“lumen diameter”) can also range from microns to millimeters. In apreferred embodiment, the diameter of the mini-tube (lumen diameter) isbetween about 5 and 200 microns. In other embodiments the diameter ofthe mini-tube (lumen) is between about 20 and 200 microns, between about50 and 175 microns, between about 100 and 200 microns, and between about150 and 300 microns. In another embodiment, the diameter of themini-tube (lumen) is between about 0.5 millimeters and 15 millimeters.In other embodiments, the diameter of the mini-tube (lumen) is betweenabout 1 millimeter and 10 millimeters, between about 1 millimeter and 5millimeters, and between about 1 millimeter and 3 millimeters.

In another embodiment of the present invention, formable, moldable,biocompatible polymeric materials are disclosed herein. Advantageously,the polymeric material may be fabricated as a putty. By “putty” it ismeant that the material has a dough-like consistency that is formable ormoldable. These materials are sufficiently and readily moldable and canbe formed into flexible three-dimensional structures or shapescomplementary to a target site to be treated.

In yet another embodiment, the biocompatible polymeric materials of thepresent invention can be fabricated into readily formable or moldablebandages, or neuropatches. In one embodiment, a SCI is localized and thebandage or neuropatch is hand-formed to complement the injured site (forexample, a hemi-sected spinal cord). The hand formed bandage is thenimplanted into the epicenter of the injury, wherein the bandage fills inthe injury site. The implanted bandage bridges any gap formed by thespinal cord lesion and functions as an artificial pathway, nurturingregrowing neurons, reorganizing neurites and helping to form functionalsynapses. This new bandage interface allows for interactions betweenendogenous neural cells (including neural stem cells, if incorporatedonto the bandage) and the inhibitory molecule-free polymer implantenvironment to promote cell survival. Furthermore, by providing astructure between the injured site and surrounding tissue (the newinterface), inflammation may be mitigated in the adjacent area wherefunctionally relevant residual cord tissue can be spared.

In another embodiment, the present invention relates to biocompatiblepolymeric bandages, which can be readily fabricated/formed into anyshape and size, comprising a single polymeric scaffold having an innersurface and an outer surface. See example 15. The formed bandages may befabricated into any geometrical shape and size. For example, the sizeand the shape of the bandage may be varied in order to deliver moreeffective relief. A thin, elongated bandage is one possibleconfiguration, but other shapes, such as elongated rectangular bandages,spheres, helical structures, and others are possible. Additionalalterations in configuration, such as the number, orientation, and shapeof the bandages may be varied in order to deliver more effective relief.For instance, the bandages may be rectangular, or any other usefulshape, and may be distributed within and/or around epicenter of thespinal cord injury. In addition, the bandage may have a textured surfaceincluding a plurality of pores and/or microgrooves on its inner and/orouter surface. In one embodiment, the pores have diameters between about0.5 μm to 4 μm and depths of at least 0.5 μm. The microgrooves may havewidths of between about 0.5 μm and 4 μm and depths of at least 0.5 μm.The sizes of the bandage, and the sizes and diameters of its pores andmicrogrooves, will vary accordingly with the spinal cord lesion to betreated. The pores and/or microgrooves on the inner and/or outer surfacemay be seeded with one or more medicinal agents, for example humanneuronal stem cells to provide cellular replacement and trophic support.In preferred embodiment, the bandage will act as a filler (i.e. fill thelesion) after implantation of the bandage within the lesioned area ofthe spinal cord, for example. In one embodiment, the bandage innersurface is flush with the lesioned spinal cord, i.e. contacts thelesion, when it is implanted.

Biocompatible polymers for the fabrication of the herein describedmini-tubes and formable bandage or neuropatch articles are well-known inthe art. In a preferred embodiment, the biocompatible polymers arebiodegradable (for example, PLGA). As used herein, biodegradable anderodible are used interchangeably. Examples of biocompatible polymersthat are biodegradable include, but are not limited to, biodegradablehydrophilic polymers such as polysaccharides, proteinaceous polymers,soluble derivatives of polysaccharides, soluble derivatives ofproteinaceous polymers, polypeptides, polyesters, polyorthoesters, andthe like. The polysaccharides may be poly-1,4-glucans, e.g., starchglycogen, amylose and amylopectin, and the like. Preferably,biodegradable hydrophilic polymers are water-soluble derivatives ofpoly-1,4-glucan, including hydrolyzed amylopectin, hydroxyalkylderivatives of hydrolyzed amylopectin such as hydroxyethyl starch (HES),hydroxyethyl amylase, dialdehyde starch, and the like. Proteinaceouspolymers and their soluble derivatives include gelation biodegradablesynthetic polypeptides, elastin, alkylated collagen, alkylated elastin,and the like. Biodegradable synthetic polypeptides includepoly-(N-hydroxyalkyl)-L-asparagine, poly-(N-hydroxyalkyl)-L-glutamine,copolymers of N-hydroxyalkyl-L-asparagine and N-hydroxyalkyl-L-glutaminewith other amino acids. Suggested amino acids include L-alanine,L-lysine, L-phenylalanine, L-leucine, L-valine, L-tyrosine, and thelike.

Definitions or further description of any of the foregoing terminologyare well known in the art and may be found by referring to any standardbiochemistry reference text such as “Biochemistry” by Albert L.Lehninger, Worth Publishers, Inc. and “Biochemistry” by Lubert Stryer,W. H. Freeman and Company, both of which are hereby incorporated byreference.

The aforementioned biodegradable hydrophilic polymers are particularlysuited for the methods and compositions of the present invention byreason of their characteristically low human toxicity and virtuallycomplete biodegradability. Of course, it will be understood that theparticular polymer utilized is not critical and a variety ofbiodegradable hydrophilic polymers may be utilized as a consequence ofthe novel processing methods of the invention.

Electrical signals in the form of action potentials are the means ofsignaling for billions of cells in the central nervous system. Numerousstudies have shown that this electrical activity is not only a means ofcommunication, but also necessary for the normal development of thenervous system and refinement of functional neural circuits. In the caseof spinal cord injury, cell-to-cell communication may be interrupted andthe mechanisms of normal neurological development imply that electricalactivity should be part of the restoration of functional connections.Such activity is important for the survival of existing cells and theincorporation of any transplanted cells (such as neural stem cells) intoworking circuits. In an embodiment of the present invention, single anddouble layer scaffolds and minitubes are fabricated from syntheticbiomaterials and are capable of conducting electricity and naturallyeroding inside the body. In an exemplary embodiment, the singlescaffold, double scaffold, or minitube comprises a biocompatible polymercapable of conducting electricity is a polypyrrole polymer. Polyaniline,polyacetyline, poly-p-phenylene, poly-p-phenylene-vinylene,polythiophene, and hemosin are examples of other biocompatible polymersthat are capable of conducting electricity and may be used inconjunction with the present invention. Other erodible, conductingpolymers are well known (for example, see Zelikin et al., ErodibleConducting Polymers for Potential Biomedical Applications, Angew. Chem.Int. Ed. Engl., 2002, 41(1):141-144). Any of the foregoing electricalconducting polymers can be applied or coated onto a malleable ormoldable article. The coated article can be also be used as a bandage,or neuropatch, as described herein.

In a preferred embodiment the biodegradable and/or bioabsorbable polymercontains a monomer selected from the group consisting of a glycolide,lactide, dioxanone, caprolactone, trimethylene carbonate, ethyleneglycol and lysine. By the terminology “contains a monomer” is intended apolymer which is produced from the specified monomer(s) or contains thespecified monomeric unit(s). The polymer can be a homopolymer, random orblock co-polymer or hetero-polymer containing any combination of thesemonomers. The material can be a random copolymer, block copolymer orblend of homopolymers, copolymers, and/or heteropolymers that containsthese monomers.

In one embodiment, the biodegradable and/or bioabsorbable polymercontains bioabsorbable and biodegradable linear aliphatic polyesterssuch as polyglycolide (PGA) and its random copolymerpoly(glycolide-co-lactide) (PGA-co-PLA). The FDA has approved thesepolymers for use in surgical applications, including medical sutures. Anadvantage of these synthetic absorbable materials is their degradabilityby simple hydrolysis of the ester backbone in aqueous environments, suchas body fluids. The degradation products are ultimately metabolized tocarbon dioxide and water or can be excreted via the kidney. Thesepolymers are different from cellulose based materials, which cannot beabsorbed by the body.

The molecular weight (MW) of the polymers used in the formable articlesof the presently described invention can vary according to the polymersused and the degradation rate desired to be achieved. In one embodiment,the average MW of the polymers in the fabricated bandage is betweenabout 1,000 and about 50,000. In another embodiment, the average MW ofthe polymers in the fabricated bandage is between about 2,000 and30,000. In yet another embodiment, the average MW is between about20,000 and 50,000 for PLGA and between about 1,000 and 3,000 forpolylysine.

The herein described mini-tubes and formable articles may beincorporated with any number of medically useful substances. In apreferred embodiment, the inner and/or outer surfaces of the mini-tubeis seeded with stem cells; for example, mesenchymal and/or neuronal stemcells, wherein the cells are deposited onto the inner (lumen in the caseof the mini-tubes) and/or outer surface(s). See FIG. 3. Theincorporation of stem cells provide for trophic support and/or cellularreplacement at the site of injury.

In another embodiment, the foregoing described polymeric articles areused in methods for providing controlled tissue healing. These methodscomprise, for example, implanting into a target compression injury sitein an animal, a system for controlled tissue healing, the systemcomprising a biodegradable and/or bioabsorbable polymeric hollow tube.The target injury site may be any injury that is susceptible tosecondary tissue injury, including but not limited to: glial scarring,myelin inhibition, demyelination, cell death, lack of neurotrophicsupport, ischemia, free-radical formation, and excitotoxicity. In oneembodiment, the injury to be treated is a spinal cord injury, whereinthe spinal cord is compressed. The herein described methods may be usedin conjunction with decompression surgery; for example, concomitant withdecompression surgery, prior to decompression surgery, or subsequent todecompression surgery.

In another embodiment, the foregoing described polymeric articles areused in methods for treating a compression spinal cord injury comprisingimplanting into a target compression injury site in an animal abiodegradable and/or bioabsorbable polymeric hollow tube. The spinalcord injury may be susceptible to secondary tissue injury, including butnot limited to: glial scarring, myelin inhibition, demyelination, celldeath, lack of neurotrophic support, ischemia, free-radical formation,and excitotoxicity. The herein described methods may be used inconjunction with decompression surgery; for example, concomitant withdecompression surgery, prior to decompression surgery, or subsequent todecompression surgery.

DESCRIPTION OF THE FIGURES

FIG. 1A and FIG. 1B. Two schematic representations (A and B) of thepolypyrrole scaffold inserted around the center of the lesion area inorder to protect surrounding tissues.

FIG. 2. Electrodeposition of erodible PPy to form mini-tube scaffolds.

FIG. 3A to FIG. 3D. SEM images of microfabricated PPy tubes. A. Murineneural stem cells seeded inside of a 600 μm inner diameter tube (150×).B. High-magnification (350×) view of 25 μm inner diameter tube. Roughsurface texture is a result of low electrodeposition temperature (4°C.). C. Lower magnification (150×) view of a 25 μm inner diameter tubecreated with a smooth surface texture by electrodeposition at 24° C. D.Higher magnification (500×) view of same tube as in C.

FIG. 4. MRI shows reduced fluid filled cyst (appears bright white in theT2 weighted MR image) formation in rodents treated with a PPy scaffold(shown on right) relative to untreated control (shown at left).

FIG. 5. Open-field locomotor scores for polypyrrole minitube-implantedrats (n=8) and lesion-control rats (n=11).

FIG. 6. BBB open-field walking scores for the four groups on theipsilateral, lesioned side. Hindlimbs were assessed independently todetermine the degree of asymmetry. The rate of improvement for thescaffold-treated group was significantly greater than the rate for thestem cells-alone (P<0.001) and lesion-control groups (P<0.004; two-wayrepeated measures of ANOVA; N=12 each group).

FIG. 7A and FIG. 7B. Spinal cord tissue protection resulting fromapplication of PLGA polymer scaffold into the penetrating lesion site isobserved at both gross pathology (FIG. 7A) and microscopic (FIG. 7B)levels.

FIG. 8A to FIG. 8E. Functional recovery analysis summary forbandage-scaffold. a, Montages of still images of animal open-fieldwalking in “lesion only” (top row) and “scaffold with high dose hNSCs”(bottom row). b, Lesion side BBB open-field walking scores. The absolutescores of groups treated with hNSCs seeded in single-scaffolds (i.e.,16-17 in average) are significantly higher than “hNSCs only” group (BBBscore of 9 in average; P=0.004 for regular dose, P<0.001 for high dose),“scaffold only” group (P=0.004 for regular dose, P=0.001 for high dose;the scaffold alone group received PLGA polymer in a single porous layerdesign, and “lesion only” group (P<0.001 for regular dose, P=0.001 forhigh dose, ANOVA, Bonferroni post hoc analysis). The rate of improvementalso shows a significantly greater value in hNSC seeded in scaffoldgroups than the “hNSCs only” group (P=0.004 for regular dose, P<0.001for high dose, two-way repeated measures of ANOVA), scaffold group(P=0.004 for regular dose, P<0.001 for high dose), and “lesion only”group (P=0.004 for regular dose, P<0.001 for high dose). c, Inclinedplane tests. When facing downward, the hNSC+scaffold treated rats couldstabilize their bodies on inclined boards angled at significantly higherdegrees (Kruskal-Wallis test, P<0.001). Parametric and non-parametricanalysis both reveal similar results. d, Pain withdrawal reflex scores.The left curve panel is the percentage of animals in each group scoring2, corresponding to normal response. The right panel is the percentageof animals in each group scoring 3, indicating hyperactive response. Thetwo panels consistently indicate that the groups receiving hNSCs seededin single-scaffolds showed significantly improved hind limb reflex whichwas correlated with hNSC doses (Pearson χ² test of independence). e,Percentage of animals in each group demonstrating normal rightingreflex. Groups receiving hNSCs seeded in single-scaffolds hadsignificantly higher percentage of rats that recovered their rightingreflex comparing to other groups (Pearson χ² test).

FIG. 9. Functional recovery in rats with penetrating injury to the T9-10spinal cord after double-scaffold PLGA implant treatment.

GLOSSARY OF TERMS

By the term biodegradable is intended a material which is broken down(usually gradually) by the body of an animal, e.g. a mammal, afterimplantation.

By the term bioabsorbable is intended a material which is absorbed orresorbed by the body of an animal, e.g. a mammal, after implantation,such that the material eventually becomes essentially non-detectable atthe site of implantation.

By the terminology “biodegradable and/or bioabsorbable article orminitube” is intended any material which is biocompatible, as well asbiodegradable and/or bioabsorbable, and capable of being formed intotubes, as described more fully herein. The material is also capable ofbeing formed into articles which is suitable for implantation into ananimal and capable of being biodegraded and/or bioabsorbed by theanimal.

The biodegradable and/or bioabsorbable articles of the present inventionare preferably biodegradable and bioabsorbable polymers. Examples ofsuitable polymers can be found in Bezwada, Rao S. et al. (1997)Poly(p-Dioxanone) and its copolymers, in Handbook of BiodegradablePolymers, A. J. Domb, J. Kost and D. M. Wiseman, editors, HardwoodAcademic Publishers, The Netherlands, pp. 29-61, the disclosure of whichis incorporated herein by reference in its entirety.

“Mini-tubes” and “tubular articles” are used interchangeably in thepresent description.

“Moldable” and “formable” are used interchangeably in the presentdescription.

DETAILED DESCRIPTION OF THE INVENTION

Described herein are devices and methods for mitigating secondary injuryto, and promoting recovery of, spinal cord primary injuries. Moreparticularly, certain embodiments of the present invention are directedto polymeric mini-tubes that may be used for the treatment of spinalcord injuries. In addition, other embodiments are directed to polymeric“fill-in” bandages that may be used for the treatment of spinal cordinjuries. For example, an erodible, or biodegradable, form ofbiocompatible polymer of the present invention is fabricated forsurgical implantation into the site of the spinal cord injury.

Certain embodiments of the present invention are directed tobiocompatible polymeric materials which can be fabricated into“mini-tubes.” These mini-tubes can be used to treat the SCI once it hasbeen localized. In one embodiment, the mini-tube is inserted into theepicenter of the injury, wherein the hollow tube runs through the injurysite. See FIG. 1. The mini-tube creates a new interface within thecompressed spinal cord parenchyma. This new interface relieves the siteof pressure and protects tissue that has been spared from injury.Pressure resulting from the compression force exerted on the cord isalleviated by (1) diffusing or redirecting the force down the surface ofthe mini-tube and away from the initial compressed site, and (2)absorbing the compression energy into the biocompatible material of themini-tube. See FIG. 1. Furthermore, by providing a structure between theinjured site and surrounding tissue (the new interface), inflammationmay be mitigated in the adjacent area where functionally relevantresidual cord tissue can be spared.

An erodible, or biodegradable, form of biocompatible polymer of thepresent invention is fabricated into a mini-tube for surgicalimplantation into the site of the spinal cord injury. Surgicalimplantation results in a target area, for example a necrotic section ofthe spinal cord, that is encapsulated by the polymer. In one embodiment,the surgery results in complete encapsulation of the target area or onlythe central necrotic area. See FIG. 1. Encapsulation of the centralnecrotic area minimizes secondary injury by inhibiting cell-cellsignaling with inflammatory cytokines Shunting the fluid-filled cystreduces pressure buildup within the cord and decreases injury toneurons. Bridging the gap formed by the cyst allows a pathway forregrowing neurons to reach the caudal side and form functional synapses.

In a preferred embodiment of the present invention, the biocompatiblepolymer is an electrically conductive material. This material allowsconduction of endogenous electrical activity from surviving neurons,thereby promoting cell survival. Any such material should bebioresorbable in situ, such that it naturally erodes once its functionhas been performed. Finally, a three-dimensional scaffold creates asubstrate by which cells can be grown in vitro and then implanted invivo. A hollow cylindrical scaffold (mini-tube) made of polypyrrole(PPy), for example, meets all of these design requirements. A schematicof the design in situ is shown in FIG. 1. In an exemplary embodiment,the biocompatible polymer capable of conducting electricity is apolypyrrole polymer. Polyaniline, polyacetyline, poly-p-phenylene,poly-p-phenylene-vinylene, polythiophene, and hemosin are examples ofother biocompatible polymers that are capable of conducting electricityand may be used in conjunction with the present invention. Othererodible, conducting polymers are well known (for example, see Zelikinet al., Erodible Conducting Polymers for Potential BiomedicalApplications, Angew. Chem. Int. Ed. Engl., 2002, 41(1):141-144).

The polymeric mini-tubes of the present invention are not limited toelectrical conducting polymers, such as PPy. Polymeric minitubes of thepresent invention may comprise one or more monomers selected from thegroup consisting of a glycolide, lactide, dioxanone, caprolactone,trimethylene carbonate, ethylene glycol and lysine, for example.Furthermore, it is possible for the polymeric bandages to comprise oneor more biodegradable and/or bioabsorbable linear aliphatic polyesters,copolymer poly(glycolide-co-lactide), and/or material derived frombiological tissue. Material derived from biological tissue can be, butis not limited to, neuronal and/or mesenchymal stem cells which can beused as medicinal agents.

As described in further detail below, a biodegradable and/orbioabsorbable polymeric tubular article of the present invention can beformed by electrodeposition of an electrical conducting polymer onto atemplate conductive wire, wherein the polymer is released from the wireby applying a reverse potential to the template conductive wire in asaline solution. The polymeric minitubes of the present invention arenot limited to electrical conducting polymers, such as PPy. Polymericminitubes of the present invention may comprise one or more monomersselected from the group consisting of a glycolide, lactide, dioxanone,caprolactone, trimethylene carbonate, ethylene glycol and lysine, forexample. Furthermore, it is possible for the polymeric minitubes tocomprise one or more biodegradable and/or bioabsorbable linear aliphaticpolyesters, copolymer poly(glycolide-co-lactide), and/or materialderived from biological tissue. Material derived from biological tissuecan be, but is not limited to, neuronal and/or mesenchymal stem cellswhich can be used as medicinal agents. See FIG. 3, for example.

An example of a type of method used to fabricate the mini-tube polymersdescribed herein is shown in FIG. 2. The pattern of the conductivetemplate for electrodeposition of polypyrrole (PPy), for example,controls the shape of the PPy scaffold that is created. By controllingthe template, the polymer scaffold can be manufactured in differentshapes and sizes, ranging from thin lines to rectangular planarimplants, for example. See Example 5. Tube-like PPy scaffolds can beproduced by plating the PPy onto a conductive wire. For scaffold removalfrom the template, a reverse potential is applied to the template in asaline solution. When applied for sufficient time and strength, thescaffold slides off of the wire mold with a slight pull. See Example 1.This method relieves the manufacturer of having to use harsh organics toetch the inner wire template, thereby resulting in polymeric devicesthat are ill-suited for use in vivo.

As described above, the mini-tubes may be fabricated into anygeometrical shape and size. For example, the size and the shape of themini-tube may be varied in order to deliver more effective relief. Athin, elongated cylinder is one possible configuration, but othershapes, such as elongated rectangular tubes, spheres, helicalstructures, and others are possible. Additional alterations inconfiguration, such as the number, orientation, and shape of themini-tubes may be varied in order to deliver more effective relief. Forinstance, the mini-tubes may be rectangular, or any other useful shape,and may be distributed along and/or around epicenter of the spinal cordinjury. The size (length and diameter) will vary accordingly with thespinal cord lesion to be treated. For example a cord lesion that is 10microns in length (running along the length of the spinal cord) and 3microns deep, may require a polymeric mini-tube of 15 microns in lengthand having an overall diameter of 2.5 microns. The polymeric mini-tubeis surgically inserted through the lesion such that the central sectionof the lesion is encapsulated by the tube. In this example, the tubewill extend approximately 2.5 microns beyond each of the caudal androstral ends of the target lesioned area. The polymeric tubular articlesof the present invention are preferred to have overall diameters ofbetween about 0.1 microns and 10 millimeters. More preferred arearticles having overall diameters of between about 50 and 175 microns.However, any size, diameter, length can be fabricated according theherein described methods in order to accommodate any lesion of thespinal cord.

The biocompatible and biodegradable polymeric mini-tubes of the presentinvention can contain pharmaceutically or biologically active substancessuch as, for example, anti-inflammatories, growth factors, and stemcells.

In another embodiment, the present invention is directed to polymeric“fill-in” bandages that may be used for the treatment of spinal cordinjuries. For example, an erodible, or biodegradable, form ofbiocompatible polymer of the present invention is fabricated forsurgical implantation into the site of the spinal cord injury. Theimplantation can be accomplished immediately after molding the bandageto conform to the injured site. The target area, for example a necroticsection of the spinal cord, may be encapsulated by the polymer, oralternatively, filled in with the formed polymer. The implantation mayresult in complete encapsulation of the target area or only the centralnecrotic area; or may result in a previously open lesioned area beingfilled in with the formed polymer. Encapsulation of the central necroticarea minimizes secondary injury by inhibiting cell-cell signaling withinflammatory cytokines Bridging the gap formed by the lesion allows apathway for regrowing neurons to reach the caudal side and the formationof functional synapses.

Optionally, an electrically conductive formable and biocompatablepolymeric material may be used to allow conduction of endogenouselectrical activity from surviving neurons, thereby promoting cellsurvival. Any such material should be bioresorbable in situ, such thatit naturally erodes once its function has been performed. Finally, athree-dimensional scaffold creates a substrate by which cells can begrown in vitro and then transplanted in vivo. A bandage scaffold made ofpolypyrrole (PPy), for example, meets all of these design requirements.A schematic of the design in situ is shown in FIG. 1.

The polymeric bandages of the present invention are not limited toelectrical conducting polymers, such as PPy. Polymeric bandages of thepresent invention may comprise one or more monomers selected from thegroup consisting of a glycolide, lactide, dioxanone, caprolactone,trimethylene carbonate, ethylene glycol and lysine, for example.Furthermore, it is possible for the polymeric bandages to comprise oneor more biodegradable and/or bioabsorbable linear aliphatic polyesters,copolymer poly(glycolide-co-lactide), and/or material derived frombiological tissue. Material derived from biological tissue can be, butis not limited to, neuronal and/or mesenchymal stem cells which can beused as medicinal agents.

The biocompatible and biodegradable polymeric bandages of the presentinvention may contain pharmaceutically or biologically active substancessuch as, for example, anti-inflammatories, growth factors, and stemcells. As described above, the polymer bandages may be fabricated intostructures wherein the outer surface is an outer scaffold having long,axially oriented pores for axonal guidance and/or radial pores to allowfluid transport and inhibit ingrowth of scar tissue. See Example 7,below. The inner surface, or inner scaffold, may be porous and seededwith one or more medicinal agents, for example human neuronal stem cellsfor cellular replacement and trophic support. Therefore, in thisparticular embodiment, the fabricated and formed bandage comprises twoscaffolds (a double scaffold) and simulates the architecture of ahealthy spinal cord through an implant consisting of a polymer scaffold,perhaps seeded with neuronal stem cells. The inner scaffold emulates thegray matter; the outer portion emulates the white matter. The bandagecan be readily designed to be tailored to fit into a variety ofcavities.

In another embodiment, the present invention relates to biocompatiblepolymeric bandages, which can be readily fabricated/formed into anyshape and size, comprising a single polymeric scaffold having an innersurface and an outer surface, wherein the formed bandages may befabricated into any geometrical shape and size. This single polymericscaffold may comprise pores (for example, on the surface making contactwith the lesion) for incorporating medicinal agents and/or depositingneural stem cells. This porous single scaffold is fabricated asdescribed in Example 15.

In another embodiment, the present invention relates to a medicalarticle suitable for implanting within a patient's spinal cord. Thearticle comprises a moldable biocompatible material comprising a 50:50blend of (1) poly(lactic-co-glycolic acid) and (2) a block copolymer ofpoly(lactic-co-glycolic acid)-polylysine. The (1)poly(lactic-co-glycolic acid) is 75% poly(lactic-co-glycolic acid) andwherein the average molecular weight is Mn ˜40,000. The (2) blockcopolymer of poly(lactic-co-glycolic acid)-polylysine is 25%poly(lactic-co-glycolic acid)-polylysine copolymer and wherein theaverage molecular weight of the poly(lactic-co-glycolic acid) block isMn ˜30,000 and the average molecular weight of the polylysine block isMn ˜2,000. In an alternative embodiment, the article comprises a singleblock of poly(lactic-co-glycolic acid). It is preferred that any of theforegoing articles have a degradation rate of about between about 30 and60 days; however, the rate can be altered to provide a desired level ofefficacy of treatment. The article may further comprise stem cells inassociation with any of the polymeric material. For example, the stemcells may be seeded onto the polymer or, more specifically, seededwithin pores on the surface of the polymer. Any stem cell type may beused. It is preferable, for the treatment of spinal cord injury, thatthe stem cells be selected from neuronal stem cells and/or mesenchymalstem cells.

In yet another embodiment, the article comprises a single scaffold of anelectrically conducting polymer, such as polypyrrole. It is preferredthat any of the foregoing articles have a degradation rate of aboutbetween about 30 and 60 days; however, the rate can be altered toprovide a desired level of efficacy of treatment. The article mayfurther comprise stem cells in association with any of the polymericmaterial. For example, the stem cells may be seeded onto the polymer or,more specifically, seeded within pores on the surface of the polymer.Any stem cell type may be used. It is preferable, for the treatment ofspinal cord injury, that the stem cells be selected from neuronal stemcells and/or mesenchymal stem cells.

In another embodiment of the present invention, a method is disclosedfor treating an open wound spinal cord injury, comprising (a) molding abiocompatible material comprising a 50:50 blend of (1)poly(lactic-co-glycolic acid) and (2) a block copolymer ofpoly(lactic-co-glycolic acid)-polylysine to conform to a lesioned areaof the spinal cord injury; and (b) filling in the lesioned area with thebiocompatible material. The (1) poly(lactic-co-glycolic acid) is 75%poly(lactic-co-glycolic acid) and wherein the average molecular weightis Mn ˜40,000. The (2) block copolymer of poly(lactic-co-glycolicacid)-polylysine is 25% poly(lactic-co-glycolic acid)-polylysinecopolymer and wherein the average molecular weight of thepoly(lactic-co-glycolic acid) block is Mn ˜30,000 and the averagemolecular weight of the polylysine block is Mn ˜2,000. It is preferredthat the material has a degradation rate of about between about 30 and60 days; however, the rate can be altered to provide a desired level ofefficacy of treatment. The material may further comprise stem cells inassociation with any of the polymeric material. For example, the stemcells may be seeded onto the polymer or, more specifically, seededwithin pores on the surface of the polymer. Any stem cell type may beused. It is preferable, for the treatment of spinal cord injury, thatthe stem cells be selected from neuronal stem cells and/or mesenchymalstem cells.

In yet another embodiment of the present invention, a method isdisclosed for treating an open wound spinal cord injury, comprisingdouble scaffold of polypyrrole to conform to a lesioned area of thespinal cord injury; and (b) filling in the lesioned area with thebiocompatible polypyrrole material. The inner surface, or innerscaffold, may be porous and seeded with one or more medicinal agents,for example human neuronal stem cells for cellular replacement and/ortrophic support. Therefore, in this particular embodiment, thefabricated and formed bandage comprises two scaffolds and simulates thearchitecture of a healthy spinal cord through an implant consisting of apolymer scaffold, perhaps seeded with neuronal stem cells. The innerscaffold emulates the gray matter; the outer scaffold (the secondscaffold) emulates the white matter by having, for example, long,axially oriented pores for axonal guidance and radial porosity to allowfluid transport and inhibiting ingrowth of scar tissue. The bandage canbe readily designed to be tailored to fit into a variety of cavities.

It is preferred that the polypyrrole has a degradation rate of aboutbetween about 30 and 60 days; however, the rate can be altered toprovide a desired level of efficacy of treatment. The material mayfurther comprise stem cells in association with any of the polymericmaterial. For example, the stem cells may be seeded onto the polymer or,more specifically, seeded within pores on the surface of the polymer.Any stem cell type may be used. It is preferable, for the treatment ofspinal cord injury, that the stem cells be selected from neuronal stemcells and/or mesenchymal stem cells.

In another embodiment of the present invention, a kit for surgicallytreating spinal cord injuries is described. The kit may include anycombination of the components, devices, and polymeric articles,discussed above, in one or more containers, including but not limitedto: one or more pre-cut polymeric bandage scaffolds and/or mini-tubescaffolds, one or more artificial dura, a trimming tool, an alignmenttool, drapes, and instructions for using the kit and components therein.The components of the kit may be packaged in a sterile manner as knownin the relevant art.

EXAMPLES

The following non-limiting examples have been carried out to illustratepreferred embodiments of the invention.

Example 1 Polypyrrole Mini-Tube Fabrication (I)

Polypyrrole tube scaffolds are created by electrodeposition of erodiblePPy at 100 μA for 30 minutes onto 250 μm diameter platinum wire. SeeFIG. 2. This is followed by reverse plating at 3 V for 5 minutes,allowing for the removal of the scaffold. See FIG. 3 (C and D).

Example 2 PPy Mini-Tubes Prevent Post-Primary Injury Cavity Formation inthe Lesioned Spinal Cord (n=13, SCI and Control Rats, Respectively)

MRI images of post-injury cavity development, studied two months postinjury, show large cavity formation in the control spinal cord (whereininjured cord was not treated with surgically implanted mini-tube), ascompared to the PPy-treated spinal cord. See FIG. 4.

Example 3 Open-Field Locomotor Scores For Polypyrrole-Implanted Rats andLesion Control Rats

Results from the polypyrrole mini-tube scaffold showed functionallocomotor improvement as early as 2 weeks post injury. The amount offunctional recovery relative to non-treated controls continues toincrease for up to 6 weeks. See FIG. 5. Treated animals are capable ofweight-bearing and functional stepping, where non-treated animals showgreatly diminished hindlimb function. Magnetic resonance images showthat the fluid filled cyst is reduced with a herein described implant.As shown in FIG. 4, the spinal cord is more intact and the cyst isbarely visible when treated with polypyrrole. Biodegradable and/orbiocompatible polymers are well known in the art and can be used in thepresent invention.

Example 4 Polypyrrole Mini-Tube Polymer Treated SCIs

Biocompatible polypyrrole polymer mini-tubes demonstrated high affinityto human neuronal stem cells. See FIGS. 3A and 3B, for example. In an invivo study, a 25 mm contusion injury was delivered via the NYU Impactoron Sprague-Dawley rats. Immediately following injury in the twotreatment groups, the cord meninges were incised with a short(approximately 1-3 mm) cut, allowing for neurosurgical decompression andcreating a space for insertion of the tube. In scaffold treatmentgroups, the implants were inserted into the cord, targeting the centralcanal and surrounding parenchyma. After implantation, the dura wascovered and sealed using the Duragen collagen matrix and overlyingtissues sutured closed.

Example 5 Fabrication of PPy Mini-Tubes (II)

Tube-like PPy scaffolds were produced by plating the PPy onto aconductive wire mold. This technique can be scaled to produce scaffoldsof any length, inner diameter, and outer diameter. Furthermore, surfaceroughness can be controlled with electroplating temperature (FIG. 2).Scaffold extraction from the template by application of a negativepotential in a saline solution. The negative potential causeselectrochemical reduction and slightly increases the size of thescaffold. It can then be mechanically dissociated from the platinum wiremold with minimal applied force, resulting in no damage to the material.This technique is an improvement on the prior method of etching theinner wire with harsh organics, making any resulting devices unsuitablefor implantation. For in vivo tests in rodents, PPy tube scaffolds werecreated by electrodeposition of erodible PPy at 100 μA for 40 min onto250 μm diameter platinum wire. This was followed by reverse plating at3V for 20 seconds, allowing removal of the scaffold. The resulting tubesof 10-15 mm length were sectioned into 3 mm long pieces forimplantation.

Example 6 Cell Maintenance and Seeding on Polymer Mini-Tubes

Murine NSCs (neuronal stem cells) were maintained in serum-containingmedium. Scaffolds were soaked in 70% ethanol for 24 hrs, rinsed threetimes in PBS, and seeded on an orbital shaker with 5×10⁵ cells/ml at 37°C. in a humidified 5% CO₂/air incubator. The medium was changed the nextday, and the implants were incubated for 4 more days beforeimplantation.

Example 7 Double Scaffold Fabrication

Both the inner and outer scaffolds were fabricated from a blend of 50:50poly(lactic-co-glycolic acid) (PLGA) (75%, number average molecularweight, Mn, ˜40,000) and a block copolymer of poly(lactic-co-glycolicacid)-polylysine (25%, PLGA block Mn ˜30,000, polylysine block Mn˜2000). The PLGA was chosen to achieve a degradation rate of about 30-60days, and the functionalized polymer was incorporated to provide sitesfor possible surface modification. The inner scaffold was made using asalt-leaching process: a 5% (wt/vol) solution of the polymer blend inchloroform was cast over salt with a diameter range of 250-500 μm, andthe solvent was allowed to evaporate. The salt was then leached inwater. The oriented outer scaffold was fabricated using a solid-liquidphase separation technique in the following way: A 5% (wt/vol) solutionof the polymers was filtered and injected into silicone tubes which werelowered at a rate of 2.6×10⁴ m/s into an ethanol/dry ice bath. Oncefrozen, the dioxane was sublimated using a shelf temperature-controlledfreeze drier (VirTis). The scaffolds were then removed, trimmed,assembled, and stored in a vacuum desiccator until use. The resultingproduct is one wherein the inner scaffold emulates gray matter via aporous polymer layer which can be seeded with stem cells, for example;and the outer scaffold emulates the white matter with long, axiallyoriented pores for axonal guidance and radial porosity to allow fluidtransport while inhibiting ingrowth of scar tissue.

Example 8

Dramatic spinal cord parenchyma protection is observed at both grosspathology (FIG. 7A) and microscopic (FIG. 7B) levels in the penetratinglesion epicenter tissue collected 8 weeks after the lesion (n=8) or theimplantation of PLGA polymer patch (n=8). Upper panels of 7A and 7B showthe penetrating lesion epicenter morphologies presented in grosspathology (7A upper panel) and microscopic images (7B upper panel).Eight weeks after initial open wound lesion (i.e., T9-T10 segmentalremoval of half spinal cord from the midline), only little amount ofscarring tissue was left to link the spinal cord. In contrast, polymerpatched spinal cord (inserted immediately after lesion) demonstratedsignificant parenchyma protection for the initially intact side of thecord; the spared tissue was clearly discernable at 8 weeks afterpenetrating lesion insult at levels of both gross pathology (7A lowerpanel) and microscopic examination (7B lower panel).

Example 9 Open-field Locomotor Scores For Polypyrrole-Implanted Rats andLesion Control Rats

Results from the polypyrrole scaffold showed functional locomotorimprovement as early as 2 weeks post injury. The amount of functionalrecovery relative to non-treated controls continues to increase for upto 6 weeks. See FIG. 5. Treated animals are capable of weight-bearingand functional stepping, where non-treated animals show greatlydiminished hindlimb function. Magnetic resonance images in FIG. 4 showthat the fluid filled cyst is reduced with a herein described implant.As shown in the figure, the spinal cord is more intact and the cyst isbarely visible when treated with polypyrrole mini-tube scaffold.Biodegradable and/or biocompatible polymers are well known in the artand can be used in the present invention.

Example 10 Functional Recovery From Implantation of PLGA ScaffoldsConfigured to Treat SCIs

Basso-Beattie-Bresnahan (BBB) scoring, the standard quantitative metricin the spinal cord injury research field, was used to evaluateopen-field locomotion at one day postsurgery and at weekly time pointsover the course of 6 weeks post-injury. Results from the PLGAdouble-scaffold configured to treat SCI showed functional locomotorimprovement as early as 2 weeks post injury. See FIG. 6. The amount offunctional recovery relative to non-treated controls continued toincrease for up to 8-10 weeks. The study was ended at the end of week 8or 10. In additional studies, rodents were kept for over one year anddemonstrated sustainable functional recovery as well as no pathology inreaction to the product. Because the average lifespan of a rat is 2years, the “one year plus” study demonstrates effectiveness of theherein described scaffolds.

Example 11 BBB Open-Field Walking Scores

BBB open-field walking scores for the four groups on the ipsilateral,lesioned side. See FIG. 9. Hindlimbs were assessed independently todetermine the degree of asymmetry. The rate of improvement for thescaffold plus cells group was significantly greater than the rate forthe cells-alone (P<0.001) and lesion-control groups (P<0.004; two-wayrepeated measures of ANOVA). Additionally, the scaffold alone treatedgroup showed significant improvement in open-field locomotion comparedwith the lesion-control group (P<0.05) (P<0.05) for all time points from14 days after SCI on, and the cells-alone group (P<0.05) at 21, 35 and42 days post injury (ANOVA, Bonferroni post hoc analysis).

Example 12 Cell Maintenance and Seeding

Murine and human NSCs (neuronal stem cells) were maintained inserum-containing medium. Saffoleds were soaked in 70% ethanol for 24hrs, rinsed three times in PBS, and seeded on an orbital shaker with5×10⁵ cells/ml at 37° C. in a humidified 5% CO₂/air incubator. Themedium was changed the next day, and the implants were incubated for 4more days before implantation.

Example 13 Histopathology

Conventional histopathologic analysis was performed on the spinal cordtissue to determine changes of lesion scale, secondary injury events andhealing processes. Microscopic images proved that the injury area wassignificantly reduced with our implant treatment. The spinal cord alsodemonstrated mitigated scarring as indicated by the reducedastrogliosis, a pathology which was impeded by both polymer plus stemcells and by polymer alone as well. is more intact and the cyst isbarely visible when treated with polypyrrole.

Example 14

The level of functional recovery after the same model of injury isfurther lifted by treatment of human NSCs seeded PLGA polymer asdemonstrated in FIG. 9. 100% of treated animals were capable ofweight-bearing and functional stepping. As shown in the figure (FIG. 9),50% of treated animals met the rigorous criteria of Consistent plantarstepping and Consistent FL-HL coordination during gait; and Toeclearance occurs frequently during forward limb advancement; Predominantpaw position is parallel at initial contact and rotated at lift off,corresponding to a BBB score of 16 or higher. None of the non-treatedcontrol animals reached this high standard of recovery, but ratherexhibited greatly diminished hind limb function.

Example 15 Single Scaffold Fabrication

The single scaffold was fabricated from a blend of 50:50poly(lactic-co-glycolic acid) (PLGA) (75%, number average molecularweight, Mn, ˜40,000) and a block copolymer of poly(lactic-co-glycolicacid)-polylysine (25%, PLGA block Mn ˜30,000, polylysine block Mn˜2000). The PLGA was chosen to achieve a degradation rate of about 30-60days, and the functionalized polymer was incorporated to provide sitesfor possible surface modification. The single scaffold was made using asalt-leaching process: a 5% (wt/vol) solution of the polymer blend inchloroform was cast over salt with a diameter range of 250-500 μm, andthe solvent was allowed to evaporate. The salt was then leached inwater. The product is a single porous polymer layer which can be seededwith stem cells, for example.

Example 16 Spinal Cord Tissue Analysis

Pathology, histology, and immunocytochemistry analysis of spinal cordtissue (via GFAP and DAPI staining of glial cells at 2 mm rostral to thelesion epicenter) revealed that PLGA scaffold alone and especially PLGAscaffold seeded with human neural stem cells markedly reduced scarringformation in the injured area. Wright's staining of infiltratedpolymorphonucleic leukocytes (PNLs) in spinal cord tissues 2 mm rostralto the lesion epicenter show that PLGA scaffold alone and especiallyPLGA scaffold seeded with human neural stem cells markedly impededinfiltration of PNLs, a major iNOs (inducible nitric oxide synthase)carrier, into the spinal cord.

Example 17 Spinal Cord Injury (SCI) Surgical Procedures and Animal Care

Surgical Procedures and Animal Care. Fifty adult female Sprague-Dawleyrats were used. Animals were anesthetized with a 4% chloral hydratesolution (360 mg/kg i.p.). Using a dissecting microscope, a laminectomywas made at the 9th-to-10th thoracic (T9-T10) spinal vertebrae, followedby a lateral hemi-section at the T9-T10 level by creating a 4-mm-longlongitudinal cut along the midline of the cord with a No. 11 surgicalblade, followed by lateral cuts at the rostral and caudal ends andremoval of the tissue by aspiration. The surgical blade was repeatedlyscraped along the ventral surface of the vertebral canal, followed byaspiration to remove any residual fibers at the lesion site. Aftergelfoam-triggered hemostasis occurred, an independent blinded observerconfirmed the adequacy of the length and breadth of the lesion. Only atthat time was the surgeon informed of the treatment (previouslyprepared) to be administered to the lesion. The lesion was affirmed apriori to be similar across all experimental groups and animals. Eitherthe full treatment, consisting of insertion of the NSC seeded scaffold(“scaffold plus cells,” n=13), or one of three control treatments wasperformed: (a) polymer implant without NSCs (“scaffold alone,” n=11; (b)NSCs suspended in medium (“cells alone,” n=12); or (c) hemi-sectionalone (“lesion control,” n=12). Surgeries were performed in a randomizedblock design. The surgeries for the implant plus controls were performedon the same day to minimize differences between groups arising from anyrefinement in surgical technique during the study, and the order wasvaried each day to reduce surgical bias. Hemi-sections were alternatedbetween the right and left sides to further reduce bias. Followingeither the full or control treatment, the musculature was sutured, skinclosed, and the animal recovered in a clean cage on a heating pad.Ringer's lactate solution (10 ml) was given daily for 7 days post-op andbladders were evacuated twice daily until reflex bladder function wasestablished.

Because immunosuppressive agents such as cyclosporin A have been shownto be neuroprotective on their own, these experiments were performedwithout such neuroimmunophilins to avoid this confounding variable.Donor cells were nevertheless present at the end of the study. Aseparate group of scaffold plus cells animals underwent the sameprocedures as above and were maintained for one year.

All procedures were reviewed and approved by the Animal Care and UseCommittee of our institutions.

Example 18 Functional Recovery Analysis Summary For Bandage-Scaffold

See FIG. 8, wherein a, Montages of still images of animal open-fieldwalking in “lesion only” (top row) and “scaffold with high dose hNSCs”(bottom row). b, Lesion side BBB open-field walking scores. The absolutescores of groups treated with hNSCs seeded in single-scaffolds (i.e.,16-17 in average) are significantly higher than “hNSCs only” group (BBBscore of 9 in average; P=0.004 for regular dose, P<0.001 for high dose),“scaffold only” group (P=0.004 for regular dose, P=0.001 for high dose,and “lesion only” group (P<0.001 for regular dose, P=0.001 for highdose, ANOVA, Bonferroni post hoc analysis). The scaffold alone groupreceived PLGA polymer in a single porous layer design. The rate ofimprovement also shows a significantly greater value in hNSC seeded inscaffold groups than the “hNSCs only” group (P=0.004 for regular dose,P<0.001 for high dose, two-way repeated measures of ANOVA), scaffoldgroup (P=0.004 for regular dose, P<0.001 for high dose), and “lesiononly” group (P=0.004 for regular dose, P<0.001 for high dose). c,Inclined plane tests. When facing downward, the hNSC+scaffold treatedrats could stabilize their bodies on inclined boards angled atsignificantly higher degrees (Kruskal-Wallis test, P<0.001). Parametricand non-parametric analysis both reveal similar results. d, Painwithdrawal reflex scores. The left curve panel is the percentage ofanimals in each group scoring 2, corresponding to normal response. Theright panel is the percentage of animals in each group scoring 3,indicating hyperactive response. The two panels consistently indicatethat the groups receiving hNSCs seeded in single-scaffolds showedsignificantly improved hind limb reflex which was correlated with hNSCdoses (Pearson χ² test of independence). e, Percentage of animals ineach group demonstrating normal righting reflex. Groups receiving hNSCsseeded in single-scaffolds had significantly higher percentage of ratsthat recovered their righting reflex comparing to other groups (Pearsonχ² test).

Although the particular aspects of the invention have been described, itwould be obvious to one skilled in the art that various othermodifications can be made without departing from the spirit and scope ofthe invention. It is therefore intended that all such changes andmodifications are within the scope of the appended claims.

We claim:
 1. A biodegradable and/or bioabsorbable polymeric tubulararticle suitable for treating a spinal cord injury in an animal, whereinthe article comprises a biodegradable and/or bioabsorbable linearaliphatic polyester.
 2. The polymeric tubular article of claim 1,wherein the linear aliphatic polyester is a polyglycolide or a copolymerpoly(glycolide-co-lactide).
 3. The polymeric tubular article of claim 1,comprising poly(lactic-co-glycolic acid).
 4. The polymeric tubulararticle of claim 1, comprising poly(lactic-co-glycolic acid)-polylysine.5. The polymeric tubular article of claim 1, comprising a blend of (1)poly(lactic-co-glycolic acid) and (2) a block copolymer ofpoly(lactic-co-glycolic acid)-polylysine.
 6. The polymeric tubulararticle of claim 1, comprising a 50:50 blend of (1)poly(lactic-co-glycolic acid) and (2) a block copolymer ofpoly(lactic-co-glycolic acid)-polylysine.
 7. The polymeric tubulararticle of claim 6, wherein the (1) poly(lactic-co-glycolic acid) is 75%poly(lactic-co-glycolic acid) and has an average molecular weight of Mn˜40,000.
 8. The polymeric tubular article of claim 6, wherein the (2)block copolymer of poly(lactic-co-glycolic acid)-polylysine is 25%poly(lactic-co-glycolic acid)-polylysine copolymer and wherein thepoly(lactic-co-glycolic acid) block has an average molecular weight ofMn ˜30,000 and the polylysine block has an average molecular weight ofMn ˜2,000.
 9. The polymeric tubular article of claim 1, wherein thearticle has an overall diameter of between about 0.1 microns and 10millimeters.
 10. The polymeric tubular article of claim 9, wherein thearticle has an overall diameter of between about 50 and 175 microns. 11.The polymeric tubular article of claim 1, comprising one or moremedicinal agents deposited onto the article.
 12. The polymeric tubulararticle of claim 1, wherein the article comprises a monomer selectedfrom the group consisting of a glycolide, lactide, dioxanone,caprolactone, trimethylene carbonate, ethylene glycol and lysine. 13.The polymeric tubular article of claim 1, wherein the article is smallerthan the length of the lesioned area of the spinal cord injury.
 14. Thepolymeric tubular article of claim 1, wherein the article is longer thanthe length of the lesioned area of the spinal cord injury.
 15. Thepolymeric tubular article of claim 14, wherein the article isapproximately 1.5 times longer than the length of the lesioned area ofthe spinal cord injury.
 16. The polymeric tubular article of claim 14,wherein the article is about 1.2 to about 3 times longer than the lengthof the lesioned area of the spinal cord injury.
 17. The polymerictubular article of claim 1, wherein the article is seeded with at leastone medicinal agent.
 18. The polymeric tubular article of claim 1,wherein the article has a degradation rate of between 30 and about 60days.
 19. The polymeric tubular article of claim 1, wherein the articlecomprises an electrically conducting polymer.
 20. The polymeric tubulararticle of claim 18, wherein the electrically conducting polymer isselected from the group consisting of polypyrrole polymer, polyaniline,polyacetyline, poly-p-phenylene, poly-p-phenylene-vinylene,polythiophene, and hemosin.
 21. The polymeric tubular article of claim2, wherein the electrically conducting polymer is polypyrrole.